Abstract
Background
Research has revealed high levels of suicide and self-harm within young adult prisoners, but many studies have not considered the applicability and validity of its measurement for both male and female prisoners. Previous studies have focused on retrospective evaluations of instruments which are not useful evidence in informing clinical practice and decision making.
Objectives
To evaluate the validation and prediction of suicide and self-harm risk in young adult prisoners.
Method
The study was divided into two stages. Stage one used a cross-sectional design of 1,166 prisoners across six HM Prisons to validate the use of three questionnaires: the Beck Depression Inventory, the Beck Hopelessness Scale and a newly devised instrument (SCOPE tool). The second stage assessed the predictive validity of the three instruments using a 4-year-follow-up study of female prisoners across two HM Prisons in UK. Self-report and official records were used to measure suicide and self-harm risk. Logistic regression methodology, receiver operator characteristic curves and Youden’s index were used to determine the range of thresholds for the three tools.
Results
Self-report measurement of suicide and self-harm behaviour using the three instruments presented a range of sensitivity and specificity values (65.9–72.3% and 64.9–74.0%, respectively). Predictive measurement of suicide and self-harm behaviour in the follow-up study presented a range of sensitivity and specificity values (54.6–80% and 62.2–69.4%, respectively).
Conclusion
Screening for self-harm and suicidal behaviour in young prisoners has generated a range of cut off points for the identification of those at risk. These serve as a bench mark for service planners and practitioners.
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References
Arboleda-Florez J, Holley HL (1989) Predicting suicide behaviours in incarcerated settings. Can J Psychiatry 34:668–674
Beck AT, Ward CH, Mendelson M et al (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571
Beck AT, Weissman A, Lester D et al (1974) The measurement of pessimism: The Hopelessness Scale. J Consult Clin Psychol 42:861–865
Beck AT, Rush AJ, Shaw BF, Emery G (1979) Cognitive therapy of depression. Guildford Press, New York
Beck AT, Steer RA, Brown GK (1996) BDI-II manual, 2nd edn. The Psychological Corporation, San Antonio
Beck AT, Brown G, Berchick RJ, Stewart BM, Steer RA (1990) Relationship between hopelessness and ultimate suicide. A replication with psychiatric patients. Am J Psychiatry 147:190–195
Boothby JL, Durham TW (1999) Screening for depression in prisoners using the Beck Depression Inventory. Crim Justice Behav 26:107–124
Crighton DA, Towl GJ (1997) Self inflicted deaths in prison in England and Wales. An analysis of the data from 1988–1990 and 1994–1995. In: Towl GJ (ed) Suicide and self injury in prisons: issues in criminological and legal psychology. The British Psychological Society, Leicester
Dyer JAT, Krietman N (1984) Hopelessness, depression and suicidal intent in parasuicide. Br J Psychiatry 144:127–133
Frühwald S, Frottier P (2005) Suicide in prison. Lancet 366:1242–1244
Gray NS, McGleish A, MacCulloch MJ (2003) Prediction of violence and self-harm in mentally disordered offenders: a prospective study of the efficacy of HCR-20, PCL-R and psychiatric symptomatology. J Consult Clin Psychol 71:443–451
Hawton K, Bergen H, Casey D, Simkin S, Palmer B, Cooper J, Kapur N, Horrock J, House A, Lilley R, Noble R, Owens D (2007) Self-harm in England: a tale of three cities. Soc Psychiatry Psychiatr Epidemiol 42:513–521
Home Office (1999) Suicide is everyones concern: a thematic review by HM Chief Inspector of Prisons in England and Wales. Research, Development and Statistics Department, London
Howard League for Penal Reform (2006) Prison weekly reports. http://www.howardleague.org/index.php?id=112. Accessed on 28th December 2006
Lader D, Singleton N, Meltzer H (1998) Psychiatric morbidity among young offenders in England and Wales. Office of National Statistics, London
McMillan D, Gilbody SM, Beresbord E, Neilly L (2007) Can we predict suicide and non-fatal self-harm with the Beck Hopelessness Scale? A meta-analysis. Psychol Med 37:769–778
O’Loughlin S, Sherwood J (2005) A 20-year review of trends in deliberate self-harm in a British town 1981–2000. Soc Psychiatry Psychiatr Epidemiol 40:446–453
Palmer EJ, Connelly R (2005) Depression hopelessness and suicide ideation among vulnerable prisoners. Crim Behav Ment Health 15:164–170
Perry AE (2005) Suicide and self-harm risk in offenders: the development of a new psychometric scale. University of York, PhD Thesis
Perry AE, Olason DT (2008) A new psychometric instrument assessing vulnerability to risk of suicide and self-harm behaviour in offenders: SCOPE. Int J Offender Ther Comp Criminol. doi:10.1177/0306624x08319418
Sackett DL, Haynes RB (2002) Evidence base of clinical diagnosis: the architecture of diagnostic research. Br Med J 324:539–554
Shaw J, Baker D, Hunt IM et al (2004) Suicide by prisoners. National clinical survey. Br J Psychiatry 184:263–267
Wetzel RD, Marguiles T, Davies R et al (1980) Hopelessness, depression and suicide intent. J Clin Psychiatry 41:159–160
White P, Cullen C, Minchris M (1999) Prison population brief. Research Development Statistics. http://www.homeoffice.gov.uk/rds/pdfs/prisdec99.pdf. Accessed 28th December 2006
Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35
Acknowledgments
Ethical approval was provided by each Governor at the prisons and the Ethics Committee, Department of Psychology, University of York. The authors would also like to thank the support of Mathew Johnson for his assistance with collecting the follow-up data for this project.
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Perry, A.E., Gilbody, S. Detecting and predicting self-harm behaviour in prisoners: a prospective psychometric analysis of three instruments. Soc Psychiat Epidemiol 44, 853–861 (2009). https://doi.org/10.1007/s00127-009-0007-7
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DOI: https://doi.org/10.1007/s00127-009-0007-7